Provider Demographics
NPI:1396734547
Name:PATEL, AMIT I (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 W ARROW HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5040
Mailing Address - Country:US
Mailing Address - Phone:909-931-4034
Mailing Address - Fax:909-931-2477
Practice Address - Street 1:1282 W ARROW HWY STE 100
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5040
Practice Address - Country:US
Practice Address - Phone:909-931-4034
Practice Address - Fax:909-931-2477
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40664207K00000X, 207KA0200X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A406640Medicare PIN
CA00A406640Medicare PIN
CAA85483Medicare UPIN